不同切口超声乳化白内障吸除术联合小梁切除术的疗效和耐受性的荟萃分析

目的：评价并比较一切口和二切口超声乳化白内障吸除术联合小梁切除术治疗白内障合并青光眼的疗效和耐受性。 方法：按照Cochrane协作网方法全面检索符合纳入标准的比较一切口和二切口超声乳化白内障吸除术联合小梁切除术的临床对照研究,将其进行荟萃分析。临床疗效的评估包括：眼压下降百分比采用标准化均差（SMD）,术后最佳矫正视力≥0.5的患者百分比采用比值比（OR）,手术成功率采用相对危险度（RR）。临床耐受性的评估采用RR。所有结果均以95%可信区间表示。数据分析采用Stata 10.1。 结果：降低眼压的临床疗效二切口术式明显优于一切口术式,差异具有统计学意义（SMD,-0.19 95% CI,-0.33到 -0.04 P=0.01） 术后最佳矫正视力≥ 0.5的患者百分比二切口术式大于一切口术式,但差异不具有统计学意义（OR,0.65 95% CI,0.30到1.39 P=0.26） 术后不加用抗青光眼药物达到靶眼压的患者百分比二切口术式大于一切口术式,但差异不具有统计学意义（RR, 0.94; 95% CI, 0.84到1.04; P=0.22） 两种术式在术后并发症方面差别无统计学意义。 结论：二切口超声乳化白内障吸除术联合小梁切除术临床疗效优于一切口术式。两种术式的术后并发症没有明显差异。     

不同切口超声乳化白内障吸除联合小梁切除术的疗效比较

目的比较白内障摘除联合小梁切除术一切口术式和二切口术式的临床疗效.方法按不同术式将45例(47只眼)拟行超声乳化白内障吸除人工晶状体植入联合小梁切除术(联合手术)患者分为一切口组29只眼和二切口组18只眼,所有病例的晶状体核硬度均不超过Ⅲ级,分析比较两组患者的术后眼压控制及并发症情况.随访13～30个月,平均18.9个月.结果术后平均眼压一切口组为(16.81±4.56)mmHg(1mmHg＝0.133kPa),较术前降低(15.32±6.67)mmHg;二切口组为(17.63±4.60)mmHg,较术前降低(16.42±6.98)mmHg.两组术后平均眼压下降差异无显著性(t＝1.44.P》0.05).结论联合手术的一切口术式和二切口术式均具有较好的降眼压作用;对于软性晶状体核白内障合并青光眼患者,两种术式的降低眼压作用基本相同.     

超声乳化白内障吸除联合小梁切除术治疗闭角型青光眼合并白内障

目的：探讨双切口白内障超声乳化吸除人工晶状体植入联合小梁切除术治疗闭角型青光眼合并白内障的临床疗效。方法：回顾分析双切口白内障超声乳化吸除人工晶状体植入联合小梁切除术治疗闭角型青光眼合并白内障患者65例70眼,术后随访3~12mo,观察视力、眼压及并发症的发生。
　　结果：术后患者视力≤0.1者2眼,>0.1~0.3者6眼,0.4~0.8者60眼,≥1.0者2眼,术后眼压在正常范围内(<21mmHg)者69眼,1眼术后出现浅前房,经治疗改善。
　　结论：双切口白内障超声乳化吸除人工晶状体植入联合小梁切除术治疗闭角型青光眼合并白内障手术成功率高,疗效佳,是一种理想的手术方式。     

不同切口超声乳化吸除术联合小梁切除术治疗白内障合并CACG

目的:评价并比较一切口和二切口超声乳化白内障吸除术联合小梁切除术治疗慢性闭角型青光眼合并白内障的疗效。方法:采用前瞻性随机对照临床试验研究,包括41例41眼具有慢性闭角型青光眼合并白内障的患者。21例行一切口超声乳化白内障吸除术联合小梁切除术,20例行二切口手术。术后观察的指标包括:术后眼内压(IOP)、抗青光眼药物使用数量、最佳矫正视力(BCVA)以及术后并发症。所有研究对象随访9mo。结果:两组研究对象术前各项指标没有差别。术后9mo,一切口组和二切口组IOP分别从术前22.7±4.9mmHg,23.7±4.7mmHg降至18.0±1.2mmHg,16.7±1.1mmHg(P<0.05)。各随访时间点两组IOP差别没有统计学意义(P>0.05)。术后9mo,两组抗青光眼药物减少和BCVA提高差异均无统计学意义(P>0.05)。两种手术方式在术后并发症方面无差异。结论:两种超声乳化白内障吸除术联合小梁切除手术方式治疗的临床疗效和术后并发症没有明显差异。     

双切口超声乳化三联术治疗青光眼合并白内障疗效观察

目的观察经透明角膜切口行白内障超声乳化及人工晶体植入联合小梁切除术治疗青光眼合并白内障的临床疗效。方法回顾分析2012年1月至8月患青光眼白内障在我院行经透明角膜切口超声乳化白内障吸除及人工晶体植入联合小梁切除术(以下简称双切口超乳三联术)的患者13例(13只眼),记录手术前、后的视力和眼压,记求手术并发症和滤过泡情况。结果术后平均眼压为12.12 mm H g,术后3个月随访,眼压控制良好,术后视力均有显著提高,术后无严重并发症发生。结论双切口超乳三联术具有损伤小,术后反应轻,双切口互不干扰,保留经典小梁切除滤过通道,可更安全有效治疗青光眼合并白内障。     

小切口非超声乳化白内障摘除联合青光眼手术治疗膨胀期白内障继发青光眼

目的探讨小切口非超声乳化白内障摘除联合青光眼手术治疗膨胀期白内障继发青光眼的疗效。方法对16例(16只眼)膨胀期白内障继发青光眼进行小切口非超声乳化白内障摘除联合青光眼手术,其中小切口非超声乳化白内障摘除、后房型人工晶状体植入联合虹膜周边切除术8只眼,联合小梁切除术6只眼;小切口非超声乳化白内障摘除联合小梁切除术2只眼。结果术后平均随访10个月,矫正视力≥0.5者占68.7%,明显提高者占93.8%。14只眼(87.5%)术后眼压正常。结论小切口非超声乳化白内障摘除联合青光眼手术治疗膨胀期白内障继发青光眼远期视力提高明显,眼压控制良好。     

超声乳化联合小梁切除术治疗青光眼白内障的疗效观察

目的:探讨超声乳化白内障吸除人工晶状体囊袋内植入联合小梁切除术治疗青光眼合并白内障临床疗效。方法:回顾36例青光眼合并白内障患者行白内障超声乳化吸除人工晶状体植入联合小梁切除术,对术后视力、眼压及并发症进行总结。结果:术后4wk平均眼压15.50±4.90mmHg。与术前30.60±6.80mmHg相比,差异有统计学意义(t=7.76,P<0.05)。术后视力明显提高,无严重并发症。结论:超声乳化白内障吸除人工晶状体囊袋内植入联合小梁切除术不但视力恢复好,而且青光眼术后并发症减轻,有利于眼压控制。     

双内切口白内障超声乳化联合小梁切除术初步报告

目的:探讨双内切口白内障超声乳化联合小梁切除术对治疗青光眼合并白内障患者的疗效。方法:经同一主切口将透明角膜切口白内障超声乳化人工晶状体植入术和小梁切除术以不同内切口集合在一起,对35例46眼青光眼合并白内障患者进行手术,术后随访1～6mo。结果:眼压:术前眼压25～69(平均38.3)mmHg,术后最终眼压8～28(平均15.6)mmHg。视力:术前视力范围光感～0.5,术后随访最佳矫正视力0.02～1.0,其中21眼≥0.5,34眼≥0.3。结论:双内切口白内障超声乳化联合小梁切除术治疗青光眼合并白内障,有效利用切口,使2种手术的相互影响降到较低,手术安全、有效。     

1.8mm微切口白内障超声乳化吸除联合青光眼小梁切除术临床观察

目的：观察同轴1.8mm微切口白内障超声乳化吸除超薄人工晶状体植入联合小梁切除术治疗青光眼合并白内障的临床疗效和安全性,并与传统的同轴3.0mm 小切口超声乳化吸除折叠人工晶状体植入联合小梁切除术进行比较。
　　方法：前瞻性对照研究。收集在我院眼科行超声乳化白内障手术的青光眼合并白内障患者36例36眼随机分为2组。微切口组：同轴1.8mm微切口白内障超声乳化吸除超薄人工晶状体植入联合小梁切除手术18例18眼：小切口组：传统同轴3.0mm小切口超声乳化吸除折叠人工晶状体植入联合小梁切除术18例18眼。分别记录两组1wk;1,3mo的视力、角膜内皮细胞密度、手术源性散光、眼压、滤过泡的形成和并发症的情况。采用均数t检验和χ2检验对数据进行统计学分析。
　　结果：术后1 wk微切口组裸眼视力优于小切口组,差异有统计学意义(P<0.05)。术后1,3mo两组矫正视力差异无统计学意义(P>0.05)。术后1wk;1,3mo两组手术源性散光差异有统计学意义(P<0.05)。术后1wk两组角膜内皮细胞密度差异有统计学意义(P<0.05)。术后1,3 mo 两组角膜内皮细胞密度差异无统计学意义( P>0.05)。术后微切口组平均眼压15.26±3.12mmHg,小切口组平均眼压14.57±2.86mmHg,两组术后眼压差异无统计学意义(P>0.05),两组术后功能型滤过泡和非功能型滤过泡比较,差异无统计学意义(P>0.05)。两组术中均未出现虹膜损伤、后囊膜破裂、前房出血等并发症。
　　结论：同轴1.8mm微切口白内障超声乳化吸除超薄人工晶状体植入联合小梁切除术与传统同轴3.0mm小切口超声乳化吸除植入折叠人工晶状体联合小梁切除术相比,能有效减少手术源性散光,是一种安全、有效、便捷的治疗白内障合并青光眼的手术方法。     

小切口非超声乳化青光眼白内障联合手术疗效观察

目的:探讨小切口非超声乳化白内障摘出人工晶状体植入联合小梁切除术治疗青光眼并发白内障的疗效。方法:回顾分析32例32眼行小切口非超声乳化白内障摘除人工晶状体植入联合小梁切除术治疗慢性闭角型青光眼并发白内障患者的临床资料。结果:术后随访6～9(平均7.3)mo,患者术后最佳矫正视力≥0.3者27眼(84%),术后所有患者眼压控制正常,平均13.50±5.30mmHg,功能性滤泡者28眼(88%),术中术后均无严重并发症。结论:小切口非超声乳化白内障囊外摘除人工晶状体植入联合青光眼小梁切除术是治疗慢性闭角型青光眼并发白内障的一种安全、有效、经济的方法。     

Efficacy and tolerability of one-site versus two-site phacotrabeculectomy: a meta-analysis

AIM: To evaluate the efficacy and tolerability of one-site versus two-site phacotrabeculectomy in the treatment of patients with coexisting cataract and glaucoma. METHODS: A comprehensive literature meta-analysis was performed according to the Cochrane Collaboration methodology to identify controlled clinical trials comparing one-site with two-site phacotrabeculectomy. The studies meeting the predefined criteria were reviewed systematically by meta-analysis. Efficacy estimates were measured by standardised mean difference (SMD) for the percentage intraocular pressure (IOP) reduction from baseline to end point, odds ratio (OR) for the percentage having a best-corrected visual acuity (BCVA) of 0.5 or better after surgery and relative risk (RR) for complete success rates. Tolerability estimates were measured by RR for adverse events. All of outcomes were reported with 95% confidence interval (CI). Data were synthesised by Stata 10.1 for Windows. RESULTS: Two-site phacotrabeculectomy was associated with numerically greater, and significant efficacy than one-site in lowering IOP (SMD, -0.19; 95% CI, -0.33 to -0.04; P=0.01). Numerically greater, but nonsignificant proportions of two-site patients than one-site patients had a BCVA of 0.5 or better (OR, 0.65; 95% CI, 0.30 to 1.39; P=0.26).Numerically greater, but nonsignificant proportions of two-site patients than one-site patients achieved the target IOP without anti-glaucoma medication at the end point (RR, 0.94; 95% CI, 0.84 to 1.04; P=0.22). Furthermore, there was nonsignificant difference in adverse events between two surgical procedures. CONCLUSION: The efficacy of two-site phacotrabecu- lectomy appears to be superior to one-site phacotrabecul- ectomy. One-site and two-site phacotrabeculectomy are similarly tolerable in postoperative adverse events.     

卢美根与噻吗心安治疗高眼压疗效对比的Meta分析

目的研究卢美根与噻吗心安在青光眼与高眼压症患者中降压的有效性,并观察不良反应。方法检索PubMed、EMBASE、The Cochrane Library Controlled Trials Register及中国生物医学文献数据库收录的有关卢美根与噻吗心安治疗青光眼与高眼压症的对照研究,并辅以手工检索、因特网搜索。对纳入的6项随机对照试验,针对眼压下降比例、达到目标眼压人数、药物不良反应3项内容进行综合分析。结果卢美根降眼压效果优于噻吗心安,差异有统计学意义（P〈0.01）[合并的加权均数差（WMD）=-2.04%,95%CI（-2.44,-1.64）]。3篇文献报道随访3个月时达到目标眼压的患者人数,卢美根组与噻吗心安组比较差异有统计学意义（P〈0.01）[合并危险比（RR）=1.87,95%CI（1.45,2.41）];2篇文献报道随访〉6个月时达到目标眼压患者人数,卢美根组与噻吗心安组比较差异有统计学意义（P〈0.01）[合并RR=1.60,95%CI（1.36,1.90）]。结膜充血及睫毛变长为拟前列腺素类抗青光眼药物2种较为常见的不良反应,其发生率卢美根组与噻吗心安组比较,差异均有统计学意义（P〈0.01）[合并RR=4.18,95%CI（2.89,6.05）、RR=9.40,95%CI（5.62,15.71）]。结论卢美根在降低眼压的程度和随访不同时期达到目标眼压的人数方面均优于噻吗心安。除结膜充血及睫毛变长的发生率卢美根组高于噻吗心安组外,2种药物均未发现有严重的药物相关不良反应。     

Phacoemulsification versus combined phacotrabeculectomy in the treatment of primary angle-closure glaucoma with cataract: a Meta-analysis

AIM: To compare the efficacy and safety of phacoemulsification (Phaco) against combined phacotrabeculectomy (Phacotrabe) in primary angle-closure glaucoma (PACG) with coexisting cataract. METHODS: By searching electronically the PubMed, EMBASE, Scientific Citation Index and Cochrane Library published up from inception to January 2014, all randomized controlled trials that matched the predefined criteria were included. The quality of included trials was evaluated according to the guidelines developed by the cochrane collaboration. And the outcomes estimating efficacy and safety of two different surgical treatments were measured and synthesised by RevMan 5.0. RESULTS: Five randomized controlled trials were selected and included in Meta-analysis with a total of 468 patients (468 eyes) with both PACG and cataract. We found that Phacotrabe had a greater intraocular pressure (IOP) lowing effect [preoperative IOP: weighted mean difference (WMD)=0.58, 95% confidence intervals (95% CI, -0.53 to 1.69), P=0.31; postoperative IOP: WMD=1.37, 95% CI (0.45 to 2.28), P=0.003], a lower number of anti-glaucoma medications [ risk ratio (RR) =0.05, 95% CI (0.02 to 0.18), P<0.00001] needed postoperatively and less serious damage of optic nerve [risk ratio (RR)=0.48, 95% CI (0.21 to 1.07), P=0.07], but a higher risk of complications [odds ratio (OR) =0.04, 95% CI (0.01 to 0.16), P<0.00001] compared with Phaco. The rest studies indicated that there had no significantly difference between the two surgical methods for postoperative best-corrected visual acuity (BCVA) [WMD=-0.05, 95% CI (-0.14 to 0.05), P=0.32] and loss of visual field [OR=1.06, 95% CI (0.61 to 1.83), P=0.83]. CONCLUSION: Phaco alone compared with Phacotrabe had a better effect in IOP reduction, whereas the security decline. Considering the number of sample size, our results remains to be further studied.     

High-dose ruthenium-106 plaque therapy for circumscribed choroidal hemangioma: a retrospective study of 25 Chinese patients

AIM: To evaluate the efficacy and safety of ruthenium-106 (106Ru) plaque radiotherapy at a dose (>50 Gy) higher than recommended (29-50 Gy) for treatment of circumscribed choroidal hemangioma (CCH) in Chinese patients. METHODS: This retrospective study included 25 symptomatic CCH patients undergoing 106Ru plaque brachytherapy involving 25 eyes between January 2005 and August 2016. Ophthalmic examination was performed at the baseline and at each post-treatment follow-up visit, using best-corrected visual acuity (BCVA), dilated fundus examination, and B-scan ultrasonography. The primary efficacy outcome measures included the changes in BCVA and hemangioma dimensions at the last followup visit from the baseline. RESULTS: The mean follow-up duration was 28.0±26.6 (range, 12-110)mo. All the hemangiomas were located in the posterior pole except for two involving the fovea. The mean apex dose of 106Ru plaque radiotherapy was 84.4±19.7 Gy. The mean BCVA improved from 41.4±29.3 (0-97) at the baseline to 53.0±33.8 (0-97) ETDRS letters at the last visit (P=0.01). The mean hemangioma height declined from 3.98±0.88 (2.40-5.50) mm to 0.84±1.63 (0-6.47) mm (P≤0.001), and the greatest linear diameter (GLD) reduced from 9.36±2.23 (6.80-15.00) to 7.40±2.45 (0-13.00) mm (P≤0.001). Hemangioma size increased in one (4%) eye with a worsened vision, and subretinal fluid completely resolved in all but one patient (4%). Radiation-related retinopathy was observed in two patients at post-treatment 9 and 11mo, respectively. CONCLUSION: 106Ru plaque brachytherapy at a dose (>50 Gy) higher than recommended (29-50 Gy) is an effective treatment regimen for symptomatic CCH associated with significantly improved visual acuity and a favorable safety profile in Chinese patients.     

A prospective randomized comparison of two techniques of combined cataract – glaucoma surgery

· Background: Small-incision cataract surgery combined with trabeculectomy offers new options for surgical treatment of patients with glaucoma and cataract. The purpose of this prospective randomized study was to compare the efficacy and safety of two different techniques of combined surgery: a one-site and a two-site approach. · Methods: Fifty eyes of 50 patients were included in this study. Twenty-five patients were randomly assigned to the one-site procedure and 25 patients to the two-site procedure. The one-site approach consisted of a superior tunnel phacoemulsification under a scleral flap with subsequent trabeculectomy. The two-site approach included a temporal corneal phacoemulsification combined with a separate-incision superior trabeculectomy. · Results: The preoperative mean intraocular pressure (IOP) of 29.8±4.9 mmHg dropped significantly to 15.9±3.2 mmHg. The mean follow-up time was 19±4.3 months (range 4–25 months). The reduction of IOP was more pronounced in the two-site group (50.1%) than in the one-site group (43%), but the difference was not statistically significant. Patients needed 2.2±1.7 antiglaucomatous medications preoperatively vs 0.52±1.39 postoperatively. Three patients (6%) required needling of encapsulated bleb, and two patients underwent a reoperation to control IOP. Mean visual acuity improved from 0.14±0.36 to 0.38±0.30 postoperatively. The most common complications after combined surgery were fibrinous exudation (24%) and hyphema (12%). · Conclusion:Both techniques of combined cataract and glaucoma surgery proved to be efficient and safe procedures to control IOP and to improve visual acuity. The reduction of IOP did not differ between the one-site approach and the two-site approach. Received: 2 February 1999 Revised version received: 12 April 1999 Accepted: 13 April 1999     

Efficiency and safety of laser photocoagulation with or without intravitreal ranibizumab for treatment of diabetic macular edema: a systematic review and Meta-analysis

AIM: To compare the therapeutic effect and safety of laser photocoagulation along with intravitreal ranibizumab (IVR) versus laser therapy in treatment of diabetic macular edema (DME). METHODS: Pertinent publications were identified through comprehensive searches of PubMed, EMBASE, Web of Science, Cochrane Library, and ClinicalTrials.gov to identify randomized clinical trials (RCTs) comparing IVR+laser to laser monotherapy in patients with DME. Therapeutic effect estimates were determined by weighted mean differences (WMD) of change from baseline in best corrected visual acuity (BCVA) and central retinal thickness (CRT) at 6, 12, or 24mo after initial treatment, and the risk ratios (RR) for the proportions of patients with at least 10 letters of improvement or reduction at 12mo. Data regarding major ocular and nonocular adverse events (AEs) were collected and analyzed. The Review Manager 5.3.5 was used. RESULTS: Six RCTs involving 2069 patients with DME were selected for this Meta-analysis. The results showed that IVR+laser significantly improved BCVA compared with laser at 6mo (WMD: 6.57; 95% CI: 4.37-8.77; P<0.00001), 12mo (WMD: 5.46; 95% CI: 4.35-6.58; P<0.00001), and 24mo (WMD: 3.42; 95% CI: 0.84-5.99; P=0.009) in patients with DME. IVR+laser was superior to laser in reducing CRT at 12mo from baseline with statistical significance (WMD: -63.46; 95% CI: -101.19 to -25.73; P=0.001). The pooled RR results showed that the proportions of patients with at least 10 letters of improvement or reduction were in favor of IVR+laser arms compared with laser (RR: 2.13; 95% CI: 1.77-2.57; P<0.00001 and RR: 0.37; 95% CI: 0.22-0.62; P=0.0002, respectively). As for AEs, the pooled results showed that a significantly higher proportion of patients suffering from conjunctival hemorrhage (study eye) and diabetic retinal edema (fellow eye) in IVR+laser group compared to laser group (RR: 3.29; 95% CI: 1.53-7.09; P=0.002 and RR: 3.02; 95% CI: 1.24-7.32; P=0.01, respectively). The incidence of other ocular and nonocular AEs considered in this Meta-analysis had no statistical difference between IVR+laser and laser alone. CONCLUSION: The results of our analysis show that IVR+laser has better availability in functional (improving BCVA) and anatomic (reducing CRT) outcomes than laser monotherapy for the treatment of DME. However, the patients who received the treatment of IVR+laser may get a higher risk of suffering from conjunctival hemorrhage (study eye) and diabetic retinal edema (fellow eye).     

Surgical and laser interventions for pseudoexfoliation glaucoma systematic review of randomized controlled trials

To assess the comparative effectiveness and safety of different surgical and laser techniques in people with pseudoexfoliation glaucoma (PXFG). We conducted a systematic review including randomized controlled trials (RCT) that compared any pair of surgical or laser treatment versus other type of intervention in PXFG. RCT were identified by a highly sensitive search of electronic databases and two individuals independently assessed trial eligibility, abstracted data and assessed risk of bias. We performed Bayesian Meta-Analysis when outcomes were comparable. The search strategy identified 6171 records. Six studies (262 subjects) were included. Two trials analyzed the same pair of surgical interventions comparing phacoemulsification as solo procedure or combined with trabecular aspiration and we performed meta-analysis. Other RCTs compared the following interventions: trabecular aspiration associated with phacoemulsification versus phacotrabeculectomy, non-penetrating deep sclerectomy associated or not with phacoemulsification, selective versus argon laser trabeculoplasty and one-site versus two-site phacotrabeculectomy. For IOP data, none of the trials reported a difference between pairs of surgical techniques, nor changes in visual acuity or number of post-operative medications. The overall risk of bias is moderate to high. There are no apparent differences in efficacy and safety, although with large uncertainty, between surgical or laser techniques for PXFG. Based on the low-quality evidence from the six studies included in this review, it is not possible to justify the preferential use of non-penetrating surgery, MIGS or trabecular aspiration (with or without cataract surgery) in PXFG. Further research is needed to determine the optimal management of this condition.Subject terms: Glaucoma, Outcomes research